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Surgery for SMA syndrome
Discussion in 'All Categories' started by David Peterson - Jun 6th, 2014 7:29 am.
David Peterson
David Peterson
Querido doctor,
Quiero preguntar qué precauciones debo tomar si no quiero que me realicen una cirugía de AME. No quiero que me operen porque tengo problemas con la anestesia. Una vez hace 5 años tuve que ingresar en la UCI después de la cirugía de mi apéndice. Soy hipersensible al agente anestésico.
re: Surgery for SMA syndrome by Dr.J S Chowhan - Jun 9th, 2014 4:19 am
Dr.J S Chowhan
Dr.J S Chowhan
Dear David Paterson
The medical treatment is only indicated in acute cases. The cure can be achieved with surgical intervention only. Reversing or removing the precipitating factor is usually successful in a patient with acute superior mesenteric artery (SMA) syndrome. Conservative initial treatment is recommended in all patients with superior mesenteric artery syndrome; this includes adequate nutrition, nasogastric decompression, and proper positioning of the patient after eating (ie, left lateral decubitus, prone, knee-to-chest position, or Goldthwaite maneuver) Enteral feeding using a double lumen nasojejunal tube passed distal to the obstruction under fluoroscopic assistance is an effective adjunct in treatment of patients with rapid severe weight loss and also eliminates the need for intravenous fluids and the risks associated with total parenteral nutrition.

In some instances, both enteral and parenteral nutritional support may be needed to provide optimal calories. The patient's weight should be monitored daily. Subsequently, the patient can be started on oral liquids followed by slow and gradual introduction of small and frequent soft meals as tolerated. Finally, regular solid foods are introduced. Metoclopramide treatment may be beneficial. Review of the literature reveals that the success rate is 100% with medical management only in cases with an acute presentation of superior mesenteric artery syndrome. You may consult the anesthetist and he may find some safer anesthetic agents.


With Regards

Dr J S Chowhan

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